CSAA's Membership Application for Consultants

2008 Membership Application for Consultants

We hereby apply for membership in the Central Station Alarm Association. If our application is approved, we agree to observe the Bylaws of the Association and give due consideration to all lawful activities that will contribute to its advancement and growth.

Contact Person / Official Representative __________________________________________

Title _____________________________________

Company Name ____________________________________________________________________________

Address __________________________________________________________________________________

_________________________________________________________________________________________

Phone Number ______________________ Fax Number _______________________

E-mail _____________________________ Web site Address _____________________________

Is this company owned or controlled by another organization? ¨ Yes ¨ No

If yes, please complete the following:

Name of Controlling Organization __________________________________________________

Address _______________________________________________________________________

All applicants must be sponsored by one CSAA Member in good standing with the Association.

Sponsor Name ____________________________________________ Telephone No. ______________________

Sponsor's Company Name ___________________________________________________________

CSAA Consultant Membership Dues : $500
NOTE: Companies outside the U. S. must pay by bank wire transfer or credit card.
For banking information, please contact Madeline McMahon, CSAA Vice President of Finance, at finance@csaaul.org or 703-242-4670, Ext. 14.

Please return this form with your one year's dues to: CSAA, 440 Maple Avenue East (#201), Vienna, VA 22180. Dues apply to the calendar year.

____Payment enclosed made payable to CSAA _______ Please charge my credit card (Visa, MasterCard, American Express)

Card Number: _________________________________Security Code (Mandatory):________Exp.Date (Mandatory):________

Name as it appears on the card: ________________________________

For more information, contact Becky Lane, CSAA's Director of Membership at 703/242-4670, Ext. 18 or memberservices@csaaul.org.

Privacy Statement: Any financial information requested on this form will be disclosed only to CSAA staff for the sole purpose of setting the appropriate dues. This information will not be made available to members of the association or any other parties.

The above information is submitted for the purpose of obtaining membership in the Central Station Alarm Association, and is warranted to be true and correct. Permission is hereby granted to CSAA to request information from the above-named sponsor or any other source. We understand that one year's fees are due and payable in advance in accordance with the terms that shall then be in effect, or otherwise directed by the Board.

Authorized Signature ________________________________

Title __________________________

Date ______________